FLOW SAFE ® CPAP - Centegra Health System · PDF fileFLOW SAFE ® CPAP . CPAP Device:...
Transcript of FLOW SAFE ® CPAP - Centegra Health System · PDF fileFLOW SAFE ® CPAP . CPAP Device:...
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M C H E N R Y W E S TE R N LA K E C O U N TY E M S
FLOW SAFE ® CPAP
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CPAP Device: Why change?
OLD: Oxy-PEEP Does not allow Meds via nebulizer PEEP measurement Shortages/recalls Packaged in lg box Headstrap may be
uncomfortable & challenging to use
3 settings
New: Flow-Safe Easier to repeat NTG Nebulizer can be used Actual PEEP measured Leaks detected Smaller package Comfortable headstrap 1 setting
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Just a reminder…how it works
CPAP works by “splinting” the lungs with a constant pressure of air
This reduces work of breathing In CHF, forces excess fluid out of alveoli &
interstitial space back into the vasculature Also decreases venous return to the heart thereby
lessening its workload Bottom line: Takes patients close to needing
intubation & rapidly reverses their condition avoiding complications & death
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CPAP
No Change SOP Indications Contraindications
Change Device Procedural steps
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CPAP
Indications Heart Failure - acute Asthma/COPD - severe Drowning - near Flail chest (w/o pneumothorax)
Contraindications Airway
Unable to obtain adequate seal Facial anomalies/injury
Breathing Inadequate resp rate/effort Pneumothorax Penetrating chest trauma
Circulation SBP <90 mmHg / DBP <60
Disability - Consciousness Decreased LOC Unable to follow commands
GI Aspiration risk Gastric distention Vomiting
Pregnant
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THIS IS HOW CPAP FEELS TO THE PATIENT!!
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FLOW SAFE ® CPAP
PEEP Manometer
Quick Release Clip
Head adjustment straps
Forehead adjustment
Pop off Valve
CPAP Valve
02 Tubing
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OXYGEN FLOW RATE = PEEP
15 L = approx 3-4 cm H2O PEEP
20 L = approx 6-7 cm H2O PEEP
25 L = approx 8.5-10 cm H2O PEEP
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TITRATE PEEP TO PATIENT’S WORK OF BREATHING
OLD PROCEDURE PEEP started at 10cm
H2O Not titrated to work of
breathing
NEW PROCEDURE START AT 15 L
WHICH EQUALS 3-4 cm H2O PEEP
Titrate up to patient response (decreased work of breathing)
Maximum PEEP 25 L or 8.5 - 10 cm H2O PEEP
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Flow-Safe® CPAP --- PEEP
Pressure manometer between CPAP valve & face mask measures actual PEEP being delivered Leak in system (e.g., lack of tight face-mask seal) will affect PEEP
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What is the PEEP?
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What is the PEEP?
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Assess PEEP as patient exhales
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EXPLAIN PROCEDURE TO PATIENT
MAY REQUIRE EXTENSIVE COACHING…… If they are anxious, a little Versed may help. See appropriate SOP
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OPEN PACKAGE
SECURELY CONNECT MASK TO VALVE/TUBING
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OPEN PACKAGE
Yellow label displays PEEP settings
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02 Flow
Attach CPAP O2 tubing to regulator/flow-meter Begin O2 flow @ 15 L If needed, slowly increase O2 to desired O2
sat/PEEP (do not exceed 30 LPM)
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UNDO 1 OR 2 OF THE QUICK RELEASE CLIP(S)
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Hold, or have pt. hold mask snuggly to face… Good face-mask seal is critical
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Tighten head straps using Velcro tabs
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Adjust forehead pad flat on forehead
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Adjust forehead pad flat on forehead
Squeeze together and raise or lower to adjust
WRONG RIGHT
Adjusted
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USE QUICK RELEASE TO ADMINISTER NITRO PER SOP
SOP: If systolic is 90 or above, give nitro every 5 minutes unlimited
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IF YOU RECEIVE PERMISSION TO USE CPAP WITH SEVERE ASTHMA/COPD & PATIENT IS WHEEZING
The patient will need a neb treatment
CONNECT NEBULIZER BETWEEN CPAP VALVE & MASK
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Capnography can be used under CPAP
CPAP with MWLCEMS Neb
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Adaptors
Some nebulizers may require an adaptor (same adapter used for in-line- nebs)
You will need this for Good Shepherd nebulizers
22 ml adaptor
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Flow-Safe® CPAP Device
PEEP depends on 1. O2 flow rate 2. Face mask seal (leak)
Oxygen concentration
depends on 1. O2 flow rate 2. Respiratory rate 3. Tidal volume
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How long tanks will last at different flow rates
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CPAP Device Transition
Attrition (use your old one, replace with a new one) Devices already on vehicles will not immediately be
replaced Transition will occur w/ replacement devices When an old device used, it will be replaced w/ new
device (as hospital stock allows) New devices available after 12-1-11
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Documentation
Document the oxygen flow rate Document the PEEP reading on the manometer This can be done in your narrative Remember to use the manometer reading when
patient exhales.
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TH A NK S TO TH E NW C E M S S YS TE M A ND K A TH Y K NO P F O R S O M E O F TH E C O NTE N T
O F TH I S P R E S E N TA TI O N
Thanks!